COVID-19: Primary Health Care mitigated inequalities in vaccination in Brazil

By analyzing the data of the beginning of the vaccination against COVID-19 in Brazil, in 2021, a study published on Wednesday (August 17th) in The Lancet Regional health - Americas indicates that primary health care was determining to mitigate the inequalities in the vaccine coverage in Brazil. The research was led by a Fiocruz researcher, in a collaboration with researchers from PUC-Rio (Pontifical Catholic University of Rio de Janeiro), the Barcelona Institute for Global Health (ISGlobal), the Institute of Studies for Health Policies (IEPS) and the D’Or Institute of Research and Teaching (Idor).

According to the research, municipalities that had low or medium Human Development Index (HDI) had lower vaccine coverage in relation to those who had a high HDI, but those inequalities were mitigated due to the presence of primary health care. The analysis also points out that the faster municipalities immunized their populations, the faster they controlled the pandemic, with a slower progression in death rates per vaccine dose applied.

The scientists described the progress of the national vaccination campaign for COVID-19 and the association between social-economical development — using the HDI as a basis — with the vaccination rate of the first shot, considering the potential protective effect of the coverage of primary health care. The period that was analyzed was from January 17th (the beginning of the vaccination campaign for COVID-19) and August 31st (before the booster shot was administered), 2021, focusing on the analysis of the dynamic of the vaccinal coverage of the adult population on the 5,570 Brazilian municipalities. In each register available in the Information System of the National Immunization Program (SI-PNI), that were analyzed in the study, there is information about the person’s demography (age, sex, place of residence), vaccine platform, dose, date and the place where the vaccine was administered.

Inequities on vaccination

During the period that was analyzed, 200,740,725 vaccine doses against COVID-19 — from different platforms — were administered in the country. By the end of the period, 63.8% of the adults had taken the first dose, and 31% had taken the two doses, while 90% of people who were aged over 60 had taken both doses. According to the study, the coverage of the first dose was different among the municipalities with high, medium and low HDI, with 72, 68 and 63 doses for every 100 habitants, respectively.

When considering the coverage of primary health care associated with vaccination and the HDI, the researchers realized that this was a crucial factor: municipalities that had good primary health care coverage had better immunization indexes. In consequence, municipalities with low HDI, but with good primary health care coverage, were able to lower quicker the death rates per dose applied.

According to one of the study’s coordinator, the Fiocruz researcher Fernando Bozza, the main focus of the research was to evaluate if, in the period that was analyzed, vulnerable populations were vaccinated with the same dynamic and speed of municipalities with high HDI. “We verified that this process did not happen in the same way. The vaccination began slowly in all municipalities, but as soon as there was an acceleration in the process, the ones with high and low HDI separated from each other, showing that the vaccination of poorer populations was not able to reach the same speed as the municipalities with higher HDI”, states the researcher.

Given this scenario, Leonardo Bastos, professor at PUC-Rio and the first author of the research, highlights the importance of primary health care, which means higher capacity and speed of vaccination: “The presence of family health care in municipalities with low and medium HDI protects the poor communities from having a low vaccine coverage. In the richer ones, it does not make a difference”, he says.

The study also analyzed the process of control of the pandemic in the municipalities, which involves indexes such as the death rates over time. It was verified that the ones who were able to vaccinate their population quicker were able to reduce the rate of death by the disease.

Next steps

This study is part of a bigger project called Effect Brazil, which analyzed the effectiveness of vaccination throughout Brazil, one of the ten projects that were funded by the Grand Challenges International COVID-19 Data Alliance (Icoda) funded by the Bill & Melinda Gates Foundation. Besides the funding of the Bill & Melinda Gates Foundation, the research was also supported by CNPq, Capes, Faperj and Instituto de Salud Carlos III.

This research and other results will be presented on Thursday (August 18th), in the seminar Looking at COVID in Favelas: science, participation and public health, such as the studies Vacina Maré, studies about long COVID and mental health, among others. The event will be held from 9h to 18h, in the Manguinhos campus (in Rio de Janeiro), with a live broadcast through Fiocruz’s YouTube channel.